Medical Outcomes Study Short Form 36

Multi-site Clinical Assessment of Myalgic Encephalomyelitis/Chronic Fatigue Syndrome (MCAM)

Documents and Forms

Document Name Document Type
Form 0920-20QS Medical Outcomes Study Short Form 36 Form and Instruction
0920-20QS Medical Outcomes Study Short Form 36 5_Medical Outcomes Study Short Form 36.pdf Form and Instruction
0920-20QS Medical Outcomes Study Short Form 36 5_Medical Outcomes Study Short Form 36.pdf Form and Instruction

Information Collection (IC) Details

IC Title:	Medical Outcomes Study Short Form 36	Agency IC Tracking Number:	0920-20QS

Is this a Common Form? Yes		IC Status: New

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	0920-20QS	Medical Outcomes Study Short Form 36	5_Medical Outcomes Study Short Form 36.pdf		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Illness Prevention

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 85	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

	Requested	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	85	85
Annual IC Time Burden (Hours)	10	10
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
No associated records found

Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.